Plantar Fasciitis: Fast Bounce Back in the NBA

We wonder, those of us afflicted by plantar fasciitis, with doctors saying that 90% of us will resolve it within 6 months, nine months, even up to 24 months of stretching and orthotics.

We wonder how the heck can NBA players sidelined by plantar fasciitis be back out in the game and pounding their feet on those hard floors within weeks. New York Knicks center-forward Marcus Camby returned to play in February after being out a month with plantar fasciitis. Chicago Bulls center Joakim Noah, who several years ago had treatment for plantar fasciitis in his left foot, on February 14 had platelet-rich-plasma (PRP) treatment for plantar fasciitis in his right foot and by March was still playing, although playing with pain, bolstered by massages and other treatments.

Other NBA players afflicted and sidelined by plantar fasciitis this season include, Boston Celtics center Greg Stiemsma, Detroit Pistons point guard BrandonKnight, Utah Jazz Forward-center Derrick Favors, Washington Wizards forward-center Nene and Los Angles Lakers forward-center Pau Gasol. Gasol not only had plantar fasciitis pain but actually tore his plantar fascia in a game against the Brooklyn Nets on February 5.

The result: he was out of commission.

The prognosis: He was back running drills little more than a month later.

What the…? How do they do it? Through an aggressive, multi-modal approach.

It helps, of course, that they have a powerful incentive of pressure to get back in the game. And, they have a host of doctors and trainers, team physicians, team orthopedists or podiatrists, physical therapists, consultants, whatever they need, and that the team is willing to pay the necessary costs.

PRP treatments, for example: Increasingly popular for pro athletes, PRP therapy can run a couple thousand bucks in cost, and it’s highly unlikely your insurance company will pay for it. The efficacy of PRP is still questioned by the medical establishment for lack of a major study demonstrating its advantage with statistics, but a lot of doctors who use it support its value for plantar fasciitis.

“I’m finding well over a good 60% success rate with PRP injections,” says Dr. Jeffrey Ross, Associate Clinical Professor in the Baylor College of Medicine and a fellow of the American College of Sports Medicine. “I’ve had lots of triathletes, marathon runners, tennis players and other athletes we’ve used it on and they’ve done well – very motivated people, getting therapy, listening to what it is they need to do.

Plantar fasciitis is common to all sports, just as common in baseball and football as in basketball, says Dr. Ross. “I work with the professional tennis organization in Houston with clay court, and plantar fasciitis is a common injury. They’re always running forward to the net and side to side, quick, explosive propulsion, going from stationary to accelerated positions.

Recovery depends a lot on how aggressive the treatment is, says Dr. Ross. “With my way of treatment, it’s like a shotgun.”

Sure, the average Joes or Janes don’t have a bevy of the field’s top experts in their locker rooms or a wealthy organization behind them to pay for everything the shotgun can unload, but everyone can take an aggressive, multi-modal approach on their own. One key in the NBA and other sports is that trainers are taking better care of it nowadays, know what to look for and treat it early, going to work right away.

People who decide to just live with it allow it to exacerbate, develop more scar tissue, says Dr. Ross. The plantar fascia, normally about 2 millimeters (mm) in thickness, can thicken to as much as 10 mm, making it that much harder to treat.

And some of this stuff can and should be done by everybody with plantar fasciitis. Two examples not covered elsewhere in this Web site:

Prescription/Customized Orthotics

Podiatrists typically will start you off with over-the-counter orthotics, and that’s all I’ve done so far myself. But “prescription” custom orthotics is something Dr. Ross highly recommends. Making these, he says, is rather like making prescription eyeglasses, but for the foot. First, you have to contact a good biomechanical podiatrist, one who can do a good analysis of the biomechanics of your foot and design the ideal prescription orthotic. The range of cost, he says, should be some $300-$500 for a pair of such orthotics, including biomechanical evaluation, gait analysis, impression castings and the cost of the device and fitting. A fairly good number of insurance companies cover orthotics, he says.

The computerized gait analysis allows the doctor to see the difference between gait in the two feet, the way you walk. “There are a lot of things we can do to determine the etiology behind why you have plantar fasciitis,” says Dr. Ross. “That’s the issue. People say oh, it’s plantar fasciitis, instead of asking why did you develop plantar fasciitis. Maybe you get rid of it, and six months later it’s coming back. Really important is that you don’t want to just treat the problem but find out what is the underlying cause or reason why you develop it.”

“Say a person is flat-footed or an excessive pronator. Or you don’t have the strength of the medial column or the metatarsal joint and that medial column collapses when the walk is straining the plantar fascia, and you’re also putting stress on the Achilles tendon. You can develop a multitude of problems through excessive pronation or supinating. If you just look at that, and correct that problem with orthotics or a stabilizing shoe, you can cure the plantar fasciitis and never have it come back again.”

There could be a limb length discrepancy or asymmetry between the two feet, and the computerized analysis can detail that as well.

Massage is said to help the plantar fascia to stretch, work on the scar tissue that thickens the plantar fascia and impairs blood flow, and relieve the entrapment of the medial calcaneal nerve beneath the heel. Pro sports teams of course have some of the best physical therapists who know how to do deep cross-friction massage on the plantar fascia, “to break up scar tissue, thickness, increase blood flow and try to break apart the adhesions and tightness that are trapping the nerve branch,” says Dr. Ross.

Cross-friction massage works across the grain of the plantar fascia, because the plantar fascia is a longitudinal structure, its collagen fibers running from front to back of the foot. You massage it by pushing fingers or thumb into the tissue and massaging across the foot.

Anybody, of course, can go to a physical therapist, and a lot of medical people suggest you at see a physical therapist who can get you started and show you how to do it yourself. To find a good physical therapist skilled in the topic of cross-friction massage, Dr. Ross suggests calling local hospitals and asking if they have a sports medicine physical therapy program. Or call a doctor and ask who he/she recommends for such physical therapy.

To massage in the other direction, along the fibers instead of across them, even the sports teams direct their athletes to roll something longitudinally under the foot. A common recommendation from podiatrists, as well from pro team medical personnel, is to roll a frozen water bottle up and down beneath the foot. There are a lot of theories on what that accomplishes, says Dr. John Wilson, a faculty member in the University of Wisconsin School of Medicine and Public Health, and a team physician for the University of Wisconsin Athletic Department. “My opinion is that it probably stretches the plantar fascia to some degree, and with the ice bottle you get a cooling effect. Some people believe that massage of that tissue, deep massage, increases blood flow to the tissue, which might augment the healing process.”

Some people suggest rolling a golf ball under the foot, but I find that its smooth surface makes it too-readily slip out from beneath the foot. Rolling a tennis ball beneath your foot, you can go side to side AND up and down the foot, says Dr. Ross. One tip he suggests is to experiment with making a slit in the tennis ball to make it a little softer, and depending on the size of the slit, you can adjust the density you want to feel under the foot.

The Web is rife with products aimed at massaging the plantar fascia. One person I know swears by the Hand and Foot Treatment Kit she bought for $40 from meltmethod.com, but who knows how much it helps to roll something under your foot? “People sometimes feel better because maybe it is creating a stretch with the pressures put on it,” says Debbie Nawoczenski, PT, PhD and professor in the Department of Physical Therapy at IthacaCollege–RochesterCenter. “There’s speculation that it’s breaking up tissue. We don’t know that to be true. You don’t see it out there as one of the recommendations on medical Web sites.”

You do see a lot of athletes using frozen water bottles as part of an extensive massage program, but pro teams have them doing it as one part of a “shotgun” approach throwing everything at the problem all at once to get them back out on the floor.

The forward position on a basketball team is probably the worst for plantar fasciitis, says Dr. Ross. “The center is always leaping for the rebound, but the power forward is the guy who is driving to the basket, leaping and landing hard on his heel, and going up for the rebound as well.”

Every position on NBA teams, of course, has players in the news with plantar fasciitis. Can the rest of us take some clues from the way they are treated and sent back fast into the game?

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